Search Results (56)

Spontaneous quadriceps tendon rupture is a very rare occurrence, notably for bilateral simultaneous ruptures. Its occurrence is commonly linked to an underlying condition that may weaken the tendons leading to rupture. We report the case of a 68-year-old Caucasian male afflicted with long-term gout who presented a bilateral simultaneous quadriceps tendon rupture (BSQTR). We showcase the clinical presentation, the surgical intervention, rehabilitation program, dynamic sonographic monitoring, and home-based rehabilitation techniques of this injury, which aimed to improve activities of daily living (ADL) and quality of life (QoL). The patient was included in a 9-week post-surgical rehabilitation program and a home-based rehabilitation program with subsequent pain management and gait reacquisition. The outcome measures included right and left knee active range of motion (AROM), pain intensity measured on Visual Analogue Scale (VAS), functioning measured through ADL score, and gait assessment on Functional Ambulation Categories (FAC). All endpoints were measured at different time points, scoring significant improvement at discharge compared to baseline (e.g., AROM increased from 0 degrees to 95 degrees, while VAS decreased from 7 to 1, ADL score increased from 6 to 10, and FAC increased from 1 to 5). Moreover, some of these outcomes continued to improve after discharge, and the effects of home-based rehabilitation program and a single hip joint manipulation were assessed at 6-month follow-up. Musculoskeletal ultrasound findings showed mature tendon structure, consistent dynamic glide, and no scarring. Full article

Objective: Lower third impacted molar extraction, despite being a routinary procedure for oral and maxillo-facial surgeons, may often result in a significantly negative impact in patient’s post-operatory quality of life. Among others, treatments based on oxygen-enriched oils have been shown to provide valuable therapeutic benefits in promoting wound healing, and therefore improving the immediate post-operatory symptomatology. The aim of this triple-blinded randomized controlled study is to supplement the existing evidence in the scientific literature by assessing the effectiveness of NovoX^®-Drop (Moss S.p.A., Lesa, Novara), a specific type of oxygen enriched oil-based device in reducing pain and inflammatory stimulus of post-surgical wounds following the extraction of lower third impacted molars. Materials and methods: Seventy-one patients undergoing surgical extraction of a single lower third impacted molar were randomly assigned to receive either NovoX^®-Drop (Group A) or a glycerin-based gel (Group B). Additionally, both patient groups followed the same standard therapy with amoxicillin-clavulanic acid and ibuprofen. Data were collected preoperative (T0) and after three (T3) and seven (T7) days postoperative in order to assess the following outcomes: mean visual analogue scale (VAS) score during the seven days protocol treatment, total duration of nonsteroidal anti-inflammatory drug (NSAID) usage, trismus (maximum mouth opening) and facial oedema. Results: Group A (treatment group) reported significatively lower pain levels at T7 compared to group B (average VAS value during the week: Group A: 3.57 ± 0.39 cm; Group B: 4.47 ± 0.40 cm; p-value = 0.0014) despite a significatively shorter period of NSAID usage (average NSAID usage duration: Group A: 2.43 ± 0.38 days; Group B: 3.38 ± 0.44 days; p-value = 0.00001). Therefore, trismus seems to be better controlled in group A, although the difference between the groups did not reach the threshold for statistical significance. Conclusions: The results of this study suggest that application of NovoX^®-Drop is capable of significantly reducing the post-operatory pain as well as NSAID usage, representing a promising and effective option for third impacted molar extraction surgery management. Full article

Background: Chronic postsurgical pain (CPSP) poses a major clinical challenge due to unresolved links between neurotrophic pathways and endoplasmic reticulum (ER) stress. While Neurotrophic Tyrosine Kinase Receptor Type 1 (NTRK1) modulates ER stress in neuropathic pain, its interaction with Insulin-Like Growth Factor II (IGF2) in CPSP remains uncharacterized, impeding targeted therapy. This study defined the spinal NTRK1-IGF2-ER stress axis in CPSP. Methods: Using a skin/muscle incision–retraction (SMIR) rat model, we integrated molecular analyses and intrathecal targeting of NTRK1 (GW441756) or IGF2 (siRNA). Results: SMIR surgery upregulated spinal NTRK1, IGF2, and ER stress mediators. NTRK1 inhibition reduced both NTRK1/IGF2 expression and ER stress, reversing mechanical allodynia. IGF2 silencing attenuated ER stress and pain but did not affect NTRK1, revealing a unidirectional signaling cascade where NTRK1 drives IGF2-dependent ER stress amplification. These findings expand understanding of stress-response networks in chronic pain. Conclusions: We show that spinal NTRK1 drives IGF2-mediated ER stress to sustain CPSP. The NTRK1-IGF2-ER stress axis represents a novel therapeutic target; NTRK1 inhibitors and IGF2 biologics offer non-opioid strategies for precision analgesia. This work advances CPSP management and demonstrates how decoding unidirectional signaling hierarchies can transform neurological disorder interventions. Full article

Effective postoperative pain management remains a major clinical challenge in spinal surgery, with poorly controlled pain affecting up to 50% of patients and contributing to delayed mobilization, prolonged hospitalization, and risk of chronic postsurgical pain. This review synthesizes current and emerging strategies in postoperative spinal pain management, tracing the evolution from opioid-centric paradigms to individualized, multimodal approaches. Multimodal analgesia (MMA) has become the cornerstone of contemporary care, combining pharmacologic agents, such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and gabapentinoids, with regional anesthesia techniques, including erector spinae plane blocks and liposomal bupivacaine. Adjunctive nonpharmacologic modalities like early mobilization, cognitive behavioral therapy, and mindfulness-based interventions further optimize recovery and address the biopsychosocial dimensions of pain. For patients with refractory pain, neuromodulation techniques such as spinal cord and peripheral nerve stimulation offer promising results. Advances in artificial intelligence (AI), biomarker discovery, and nanotechnology are poised to enhance personalized pain protocols through predictive modeling and targeted drug delivery. Enhanced recovery after surgery protocols, which integrate many of these strategies, have been shown to reduce opioid use, hospital length of stay, and complication rates. Nevertheless, variability in implementation and the need for individualized protocols remain key challenges. Future directions include AI-guided analytics, regenerative therapies, and expanded research on long-term functional outcomes. This review provides an evidence-based framework for pain control following spinal surgery, emphasizing integration of multimodal and innovative approaches tailored to diverse patient populations. Full article

Total hip arthroplasty (THA) is the definitive treatment for end-stage hip osteoarthritis, reliably relieving pain and restoring joint function. However, patient-reported quality of life (QoL) after THA remains heterogeneous, with recovery trajectories influenced by a range of biological, psychological, and social factors. A comprehensive synthesis of these determinants is lacking, limiting our ability to optimize individualized perioperative care and long-term outcomes. This review examines the various factors impacting quality of life (QoL) before and after hip arthroplasty. An analysis of 67 studies reveals significant postoperative enhancements in physical function, pain alleviation, and overall patient satisfaction. Identified key factors encompass physical activity, mental health status (anxiety and depression), lifestyle choices (diet and weight management), and social support systems, particularly from spouses and family members. The review indicates that, although these elements positively influence recovery, it also recognizes limitations including dependence on subjective, self-reported QoL measures, possible selection biases, and inconsistencies in study design. The results indicate that a com-prehensive, patient-focused strategy—integrating organized rehabilitation, psychological assistance, and family engagement—can markedly improve recovery and long-term QoL for arthroplasty patients. Nonetheless, additional research employing standardized protocols and extended follow-up durations is essential to corroborate these findings and guide clinical practice. The early implementation of tailored, multidisciplinary perioperative pathways—including structured rehabilitation programs, routine psychological screening and intervention, nutritional counseling for weight management, and active family involvement—may optimize functional recovery, reduce complications, and maximize long-term QoL in patients undergoing THA. This review highlights the importance of a multidisciplinary approach to enhance post-surgical quality of life, thereby advancing the understanding of patient-centered recovery strategies in orthopedic care. Full article

Background/Objectives: The inadequate management of postsurgical pain represents a major clinical issue, often leading to suboptimal outcomes in the immediate postoperative period and an increased risk of developing chronic postsurgical pain. The present study aimed to examine the relationship between postsurgical pain, mood, and the use of prescribed analgesics after total knee arthroplasty (TKA). Methods: This prospective observational explorative study enrolled 28 patients scheduled for TKA between February 2018 and March 2019. Using a digital experience sampling method (ESM) tool that included questions on pain, analgesic use, and both positive and negative effects, patients reported their current status up to ten times daily. The questions were administered over five days following postoperative discharge. Data analysis was performed using descriptive statistics and multilevel regression, accounting for the hierarchical structure of the data. Results: On 85.5% of the days post-discharge, the patients did not adhere to the prescribed acetaminophen regimen. Multilevel analyses revealed that the groups who overused or underused acetaminophen reported significantly heightened levels of pain. NSAIDs were generally underused. Post-discharge opioid use decreased over time, with no evidence of abuse. Overall, the non-adherent group reported lower mood levels and higher pain scores than the adherent group. Conclusions: Most patients did not adhere to the prescribed analgesics despite experiencing pain. Therefore, clinical interventions should prioritize identifying patient subtypes to tailor analgesic use effectively. This approach will facilitate the development and improvement of personalized acute postsurgical pain treatment protocols, ensuring more precise and effective pain management strategies for patients. Full article

Background/Objectives: Functional spinal instability from multifidus dysfunction has been proposed as a mechanism for chronic postsurgical pain. Prior studies reported structural impairments in the lumbar multifidus in patients with chronic low back pain, including a reduced cross-sectional area, muscle thickness, and increased fat infiltration. This preliminary report examined the prevalence of multifidus fat infiltration after Spinal Cord Stimulation (SCS), an established pain management technique. It also assessed inter-rater reliability in evaluating fat infiltration using MRI. Methods: The medical imaging data from four patients with Persistent Spinal Pain Syndrome Type II (PSPS II) treated with SCS were collected. Two independent operators performed the manual segmentation of the multifidus muscle on axial MRI images of the lumbar spine. The fat-to-muscle ratio was quantified and rated using a four-point classification system, categorizing multifidus fat infiltration as normal, mild, moderate, or severe. To assess the reliability of the manual segmentations, inter-rater reliability was determined. Results: The median fat-to-muscle ratio at the levels L2–L3 was 46.12 (Q1–Q3: 44.88–47.35). At the levels L3–L4, L4–L5, and L5–S1, the median values were 50.45 (Q1–Q3: 45.57–52.98), 52.11 (Q1–Q3: 48.81–52.80), and 52.84 (Q1–Q3: 49.09–56.39), respectively. An ICC value of one (95% CI from 0.999 to 1, p < 0.001) was found for inter-rater agreement on the muscle volume of the multifidus muscle. Conclusions: All the patients had moderate-to-severe fat infiltration of the multifidus muscle at each lumbar spinal level. Although time-consuming, the manual segmentation of the multifidus muscle in patients treated with SCS was feasible and yielded excellent inter-rater reliability when determining muscle volume. Future endeavors should focus on the automation of segmentation and classification. Full article

Background: Third molar (M3) removal is considered one of the most frequent oral surgical procedures worldwide. Indications for extraction include both prophylactic and therapeutic reasons. However, this does not come without complications, and despite the widespread practice, there is no consensus on whether prophylactic M3 extraction is more beneficial than conservative management. Aims: The aim of this systematic review is to highlight and compare the main differences and outcomes between prophylactic and therapeutic removal of third molars with conservative treatment and observation. Several factors have been considered such as post-surgical infection risks and complications, hospitalization indications, economic factors and periodontal health of adjacent teeth. Methods: A literature review and meta-analysis were conducted, which comprises studies describing the incidence of postoperative complications, the periodontal status of the second molar (M2), the prevalence of caries, and the economic aspects of the M3 removal. Periodontal parameters of the adjacent teeth such as periodontal pocket depth (PPD) and clinical attachment level (CAL), as well as inferior alveolar nerve (IAN) damage and post-operative inflammatory complications such as bacteremia, were considered. Finally, hospitalization and the economic burden of this procedure were also stated. Results: Third molar retention is associated with increased periodontal disease such as PPD and accumulation of plaque to the adjacent teeth, as well as risk of caries. Contrarily, prophylactic M3 extraction is often linked to unnecessary morbidity and costs, such as risk of bacteremia, trismus, postoperative pain, IAN damage, and sometimes the need for hospitalization. From an economic aspect, this frequent procedure is mostly associated with higher direct and indirect costs, which can exceed the amount of EUR 1000 per patient without hospitalization. Conclusions: This review tried to determine whether the M3 observation and retention can be more beneficial than M3 extraction, after examining certain parameters. Findings indicate that unnecessary morbidity and costs can be attributed to third molar extraction, with postoperative complications such as pain and trismus and sometimes the need for hospitalization. Transient bacteremia also accompanies third molar removal. Full article

Objectives: Endodontic microsurgery has become an integral part of daily endodontic practice. However, research on the correlation between the lesion characteristics observed via cone beam computed tomography (CBCT) and pain and swelling after endodontic microsurgery (EMS) is still lacking in the literature. The present study aims to examine the relationship between the radiographic characteristics of preoperative periapical lesions obtained from CBCT images and post-surgical symptoms such as pain and swelling. Materials and Methods: A total of 61 patients undergoing EMS utilizing modern techniques were asked to report their level of pain and swelling at 8, 24, 48, and 72 h after EMS using VAS. Independent variables such as age, gender, tooth location, CBCT periapical index, endodontic diagnosis, cortical bone perforation by the lesion, duration of the EMS, preoperative analgesic consumption, antibiotic prescription, and pre-/postoperative mouthwash were analyzed using the Fisher Exact test. Multivariate regression analysis was also conducted to determine the independent significant factors associated with pain and swelling. A p-value of ≤0.05 was considered statistically significant. Results: The maximum pain score was recorded at 8 h (4.26 ± 3.13), while peak swelling was measured after 24 h (6.46 ± 2.87). The risk of swelling was more likely to decrease by 75.7% for patients with a CBCT index score of >3 than those with a CBCT index score of ≤3 (AOR = 0.243; CI = 0.071–0.831; p = 0.024). The effects of all other factors on pain, including cortical bone perforation by the lesion (p = 0.290), swelling (p = 0.071), postoperative mouthwash use (p = 0.062), and swelling (p = 0.934), did not reach statistical significance. Conclusions: Patients with periapical lesions larger than 4 mm will likely experience less swelling after EMS, while pain is not affected by lesion size, cortical bone perforation, or mouthwash use. Clinical Relevance: This study identified a new predictor of swelling after EMS based on the size of the periapical lesion. These results will improve the management of post-surgical sequelae after EMS and support shared decision making. Full article

Endermologie is a non-invasive mechanical massage technique that combines suction, mechanized rollers and/or flaps, and mechanotransduction principles to stimulate the skin and subcutaneous tissues. This review assessed endermologie’s therapeutic indications and physiological effects. A comprehensive literature search was conducted using EDS DB (Med Univ) and PubMed to identify relevant studies published between 2000 and February 2025. Two authors independently screened studies, resulting in 24 articles included in the qualitative synthesis. Key applications identified included for burns, scars, muscle regeneration, lymphedema, cellulite, panniculitis/lipoatrophy, skin elasticity improvement, fat reduction, morphea, fibromyalgia, pre- and post-liposuction care, peri-oncology rehabilitation, orthopedics, and postoperative recovery. Research highlights the importance of treatment frequency, duration, and mechanostimulation parameters in determining therapeutic outcomes. Studies indicate that endermologie induces extracellular matrix remodeling, fibroblast activation, adipocyte fat release sensitivity, and enhanced venolymphatic circulation. Documented effects include improved microcirculation, anti-fibrotic properties, enhanced skin elasticity, fluid drainage, and pain relief, contributing to scar management, tissue softening, and post-surgical rehabilitation. Despite its potential, methodological heterogeneity across studies limits direct comparability, emphasizing the need for future research on standardization and long-term efficacy validation. Full article

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease that frequently causes foot deformities, decreasing mobility and quality of life. Although surgical interventions seek to alleviate these alterations, the long-term experiences of patients have not been deeply explored. The aim of this study was to describe the experiences of patients with RA undergoing osteoarticular surgery to correct acquired foot deformities. Materials and Method: A qualitative study design was used with structured interviews including 19 patients with RA treated in a specialised rheumatology service. The thematic analysis was carried out using the Braun and Clarke thematic analysis, ensuring compliance with ethical standards and the anonymity of the participants. Results: Five main themes were identified: experience with pain before and after surgery; impact on functional capacity; complications and need for additional surgeries; emotional impact and quality of life; overall satisfaction with the surgery. While many patients reported significant pain reduction and functional improvements, others faced recurrences of the deformities, persistent pain, and post-surgical complications. Emotional responses ranged from well-being to frustration, depending on surgical outcomes. The five-year follow-up period allowed for a comprehensive assessment of the long-term impact of surgery. The recurrence rate of deformities was notable, and the emotional impact of these recurrences was significant, with patients expressing frustration and distress in some cases. Conclusions: The patients’ experiences were heterogeneous, with both positive and negative outcomes. These findings underscore the importance of individualized management and comprehensive follow-up that consider the clinical outcomes, expectations, and emotional well-being of RA patients undergoing foot surgery. Full article

Background: Opioid analgesic therapy has been traditionally used for pain management; however, the variability in patient characteristics, complexity in evaluating pain, availability of treatment within facilities, and U.S. physicians overprescribing opioids have contributed to the current opioid epidemic. Despite large research efforts investigating the patterns of postsurgical pain management and influencing factors, it remains unclear how these overall trends vary across the varying sizes and available resources of academic hospitals, community hospitals, and outpatient surgery centers. The primary aim of this scoping review was to examine the patterns of contemporary postoperative pain management across healthcare settings, including academic medical centers, community hospitals, and outpatient surgery centers. Specifically, this study investigates how prescription practices for opioids, NSAIDs, and acetaminophen are influenced by patient demographics, including sex, race, gender, insurance status, and other social determinants of health (SDoH), to inform equitable and patient-centered pain management strategies. Methods: This study utilized The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and was used as a reference checklist. The Arksey and O’Malley methodological framework was used to guide the review process. To ensure comprehensive coverage, searches were conducted across three major databases: PubMed, Embase, and Cochrane Library. Results: A total of 43 eligible studies were retained for analysis. The highest reported Healthy People 2030 category was Social and community context (n = 39), while the highest reported category of SDoH was age (n = 36). A total of 34 articles listed sex and age as SDoH. Additional SDoH examined were race/ethnicity (n = 17), insurance (n = 7), employment (n = 1), education (n = 4), and income (n = 1). This review suggests that there are significant gaps in the implementation of institution-specific, patient-centered, and equitable pain management strategies, particularly in academic hospitals, which our findings show have the highest rates of opioid and NSAID prescriptions (n = 26) compared to outpatient surgical centers (n = 8). Findings from our review of the literature demonstrated that while academic hospitals often adopt enhanced recovery protocols aimed at reducing opioid dependence, these protocols can fail to address the diverse needs of at-risk populations, such as those with chronic substance use, low socioeconomic status, or racial and ethnic minorities. Conclusions: Findings from this review are expected to have implications for informing both organizational-specific and nationwide policy recommendations, potentially leading to more personalized and equitable pain management strategies across different healthcare settings. These include guidelines for clinicians on addressing various aspects of postoperative pain management, including preoperative education, perioperative pain management planning, use of different pharmacological and nonpharmacological modalities, organizational policies, and transition to outpatient care. Full article

Neuropathic pain (NP) is a common complication associated with some types of childhood cancer, mainly due to nerve compression, chronic post-surgical pain, chemotherapy, and radiotherapy. NP is usually less responsive to traditional analgesics, and there is generally a lack of evidence on its management in cancer patients, leading to recommendations often based on clinical trials conducted on other forms of non-malignant NP. In pediatric oncology, managing NP is still very challenging for physicians. Different factors contribute to increasing the risk of undertreatment: (a) children may be unable to describe the quality of pain; therefore, the risk for NP to be underestimated or remain unrecognized; (b) specific tools to diagnose NP have not been validated in children; (c) there is a lack of randomized clinical trials involving children, with most evidence being based on case series and case reports; (d) most drugs used for adult patients are not approved for childhood cancers, and drug regulation varies among different countries; (e) recommendations for pediatric pain treatment are still not available. In this paper, a multidisciplinary team will review the current literature regarding children with cancer-related NP to define the best possible diagnostic strategies (e.g., clinical and instrumental tests) and propose a therapeutic care pathway, including both non-pharmacological and pharmacological approaches, which could help pediatricians, oncologists, neurologists, and pain therapists in designing the most effective multidisciplinary approach. Full article

Background/Objectives: CAPTRANE evaluated the efficacy and tolerability of high-concentration capsaicin patch (HCCP) vs. oral pregabalin for the treatment of postsurgical neuropathic pain (PSNP) following breast cancer surgery. The study was designed with the aim of demonstrating noninferiority of one HCCP against daily pregabalin. Methods: This was a multicenter, randomized, parallel-arm, open-label study conducted across nine centers in France. The primary endpoint was a change from baseline in the Numeric Pain Rating Scale (NPRS) score after 2 months. Results: Recruitment challenges resulted in the randomization of 140 patients (versus 644 planned); the per-protocol population comprised 107 patients (HCCP: n = 65; pregabalin: n = 42). Baseline characteristics were similar between the two groups. In the per-protocol analysis, the mean (standard deviation) change versus baseline in NPRS score was −1.926 (2.554) with HCCP and −1.634 (2.498) with pregabalin. The prespecified analysis showed that HCCP was not inferior to pregabalin: the lower bound of the 90% confidence interval for the between-arm difference was −0.889 and the upper bound was +0.260 (i.e., below the predefined clinical threshold of +0.4). Patient-reported outcomes showed no statistically significant differences between treatments. The painful area size decreased significantly more with HCCP. Tolerability profiles differed, with HCCP mostly causing application-site reactions. While >50% of patients switched from pregabalin to HCCP, none switched from HCCP to pregabalin. Conclusions: This comparative study in PSNP post breast cancer surgery, evaluating a single treatment of HCCP, shows a noninferior reduction in pain intensity, a superior reduction in painful area size, and a patient preference for HCCP compared with pregabalin. Despite limitations, it contributes valuable initial data for PSNP management in breast cancer care. Full article

Background: While multimodal analgesia is the standard of care for postoperative pain relief, opioid medications continue to be a part of the treatment regimen, especially for more invasive surgeries such as spinal fusion, craniofacial reconstruction, laparotomy, and others. In pediatric patients, safe usage, storage, and dosing are especially important, along with clear instructions to caregivers on how to manage their child’s pain. Combination opioids such as hydrocodone with acetaminophen and acetaminophen with codeine are the most commonly prescribed opioid medications for postoperative pain control. However, these combination products can lead to acetaminophen toxicity, limit the ability to prescribe acetaminophen or ibuprofen, and add to caregiver confusion. Administering acetaminophen and ibuprofen individually rather than in combination products allows the maximal dosing of these nonopioid medications. The primary aim of this quality improvement (QI) project was to increase the utilization of single-agent opioids for postoperative pain control, primarily oxycodone, by the various surgical groups here at Cook Children’s Medical Center (CCMC). Methods: The project setting was a tertiary-level children’s hospital with a level 2 trauma center, performing over 20,000 surgeries annually. The opioid stewardship committee (OSC) mapped the steps and overlapping activities in the intervention that led to changes in providers’ prescription practices. A Plan–Do–Study–Act continuous improvement cycle allowed for an assessment and modification of implementation strategies. Statistical control process charts were used to detect the average percentage change in surgical specialties using single-agent opioid therapy. Data were monitored for three periods: one-year pre-intervention, one-year post-intervention, and one-year sustainment periods. Results: There were 4885 (41%) pre-intervention procedures, 3973 (33%) post-intervention procedures, and 3180 (26%) sustainment period procedures that received opioids. During the pre-intervention period, the average proportion of single-agent opioids prescribed was 8%. This average shifted to 89% for the first five months of the post-intervention period, then to 91% for the remainder of the study. Conclusions: The methodical application of process improvement strategies can result in a sustained change from outpatient post-surgical combination opioid prescriptions to single-agent opioid prescriptions in multiple surgical departments. Full article